Public safety dispatchers enlist public to save lives

by Jim Walsh - Nov. 9, 2011 11:43 AMThe Arizona Republic

Mesa and Gilbert firefighters are saving more victims of cardiac arrest through revamped cardiopulmonary-resuscitation methods.

But they're excited about a new approach to getting the public to help save even more now that Mesa Fire Department dispatchers are asking callers two critical questions and then using a more assertive approach in enlisting the callers' assistance until paramedics arrive.

Mesa, which also dispatches for the Gilbert, Queen Creek and Apache Junction fire departments, on Monday became the first Arizona dispatch center to use the simplified protocol.

The protocol involves two simple, straightforward questions:

- Is the patient breathing normally?

- Is the patient conscious now?

If the answer to both questions is no, the dispatcher explains to the caller how to perform compression-only CPR, to alleviate any hesitancy on the part of the caller.

Dr. Ben Bobrow, Arizona's Emergency Medical Services director, hopes Mesa's success will become a statewide model for other dispatch centers and the effort will save hundreds of lives.

Bystanders assist with CPR in only 30 percent of sudden-cardiac-arrest calls nationally and 40 percent in Arizona, and many dispatch centers around the state give no lifesaving instructions, he said.

"What we hope is that this new protocol will get more people to perform CPR," Bobrow said.

He said 15 Arizonans die every day from sudden cardiac arrest and 300,000 die nationwide every year when their hearts suddenly stop beating, usually the result of a clogged artery or arteries. On average, Mesa dispatchers receive one cardiac-arrest call per day, but some days are worse.

"Our hope is, with this new line of questioning, we can get them to do compressions within one minute of calling," said Capt. John Tobin, director of Emergency Medical Services for the Mesa Fire Department.

Gilbert Fire Capt. Mike Connor said bystanders who perform CPR buy valuable time in life-or-death situations until firefighters arrive and can use a defibrillator to shock a victim's heart back into action. "It's not just getting a pulse. It's getting that person walking out of the hospital," Connor said.

In most cases, patients have enough oxygen in their blood and the critical need is to pump blood through the body and restore circulation, Tobin said.

Exceptions include drowning, seizures, choking and trauma codes, which include traffic accidents and shootings. Children younger than 9 also still require traditional CPR.

Traditional CPR involves airway, breath and compression, but studies have concluded that compressions are the most vital in saving lives. A year ago, the American Heart Association issued new CPR guidelines, authored in part by Bobrow.

The guidelines recommended that dispatchers instruct the public on compression-only CPR, but Mesa is the first Arizona agency to put that advice into action.

The new protocol, which skips the breathing instructions, is the first major change in procedure since dispatchers started instructing callers on CPR in 1990, said dispatcher Doreen Wasick said.

"If we can get them to do bystander CPR, we can triple that person's chance for survival," said Wasick, a lead dispatcher with more than 20 years of experience in Mesa. "We can assist in saving someone's life."

An overhaul of CPR procedures has paid huge dividends during the past five years, boosting survival rates, Bobrow said. Paramedics started using the new procedures, which were then promoted on a state website, www.azshare.gov. The final step is getting bystanders to help more often and more effectively.

Mesa's survival rates on cardiac-arrest calls involving ventricular fibrillation, a major cause of cardiac arrest, increased from 33 percent in 2008 to 57 percent this year, Tobin said. With the help of bystanders, he would like to see the save rate soar to 75 percent.

Wasick said explaining how to perform CPR to people suffering through one of the most stressful moments of their lives has never been an easy job.

In some incidents, callers are too hysterical to help, but sudden-cardiac-arrest callers are different, she said.

"When you give them something to do, it calms them," Wasick said.

Regardless of the type of call, explaining the breathing part and getting people to cooperate has always been a major obstacle, she said.

The Mesa program is modeled after a similar program in King County, Wash., which includes Seattle. Mesa fire officials attended a training seminar there in May.

Ann Doll, who coordinates the King County Resuscitation Academy, said every minute of delay without CPR represents a 10 percent decline in the probability of survival. Mesa's goal is a 4-minute response time, though officials concede it's often longer.

She said dispatchers must take control of stressful situations to help the victim.

"I think people respond to dispatcher who sounds like they know what they're doing," Doll said. "Literally, seconds count when we are trying to snatch life from the jaws of death."

Tobin said every cardiac-arrest call will be recorded and evaluated, with dispatchers receiving instructions on how to handle the calls more effectively if necessary. All dispatchers also were trained on the proper procedures for performing compressions so they can describe it clearly to callers.

Sudden cardiac arrest

What it is: Sudden cardiac arrest is the unexpected loss of heart function, breathing and consciousness. It usually results from an electrical disturbance in the heart that affects its pumping action, stopping blood flow to the rest of the body. Sudden cardiac arrest is different from a heart attack, which occurs when blood flow to a portion of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.

Symptoms: Frequent episodes of chest pain or discomfort, heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, fainting or near fainting, lightheadedness or dizziness. When sudden cardiac arrest occurs, the brain is the first part of the body to suffer because, unlike other organs, it doesn't have a reserve of oxygen-rich blood. Reduced blood flow to ther brain causes unconsciousness.

Treatment: If not treated immediately, it can cause death. With fast, appropriate medical care, survival is possible. Administering cardiopulmonary resuscitation - or even just rapid compressions to the chest - can improve the chances of survival until emergency personnel arrive.

Risks: If heart rhythm doesn't rapidly return, brain damage occurs and death results. If sudden cardiac arrest lasts more than 10 minutes, survival is rare. Survivors of cardiac arrest may show signs of brain damage.